Criticism of Howard University Hospital Residency Programs Raises QuestionsBy Cheryl D. FieldsWASHINGTONAn unfavorable assessment by the Accrediting Council of Graduate Medical Education (ACGME) of the residency programs at Howard University Hospital has generated a flurry of activity, including a major story in the Washington Post and the subsequent reorganization of the oversight committee that manages its medical residency programs. But some in the national medical community are crying foul, asserting that the controversy may be designed to discredit the nation’s leading Black teaching hospital, which like so many other academic medical centers, is struggling to maintain its educational mission amid the pressures of managed care.HUH Medical Director Dr. Thomas Gaiter and other hospital officials declined to be interviewed by Black Issues. But, Dr. Lucille C. Perez, president of the National Medical Association, says she finds it disturbingly coincidental that the ACGME findings have been thrust into public view only a few weeks after the Institutes of Medicine released a report stating that African Americans feel they receive a higher quality of health care when treated by African American caregivers. The IOM report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” was released in March. It found that minorities tend to receive a lower quality of health care than Whites, even when insurance status, income, age and severity of conditions are comparable (see Black Issues, May 23).“I would say that whenever anything like that goes out, we should expect a hit from Satan,” Perez says. “We should have been prepared. We should have expected that someone would come about and try to discredit one of the major institutions responsible for training so many African American physicians.”The hospital was first contacted about the ACGME’s unfavorable assessment of its residency programs in the fall of 2000. But widespread public knowledge of the situation did not come until last month, when an article in the Washington Post revealed that three of the hospital’s residency programs are in jeopardy of being shut down by the accrediting agency as early as July. Hospital officials are in the process of appealing the findings, but, meanwhile the board of trustees has reorganized the resident oversight committee and there are indications that the hospital’s assistant medical director, Dr. William E. Matory, has been removed from managing the residency program. While only three programs — emergency medicine, family practice and pediatrics — are in immediate danger, four others are also on probation, according to the ACGME. These include anesthesiology, pathology, radiation oncology and urology. A fifth program, pulmonary disease, has had its accreditation extended with a warning and a sixth program, obstetrics and gynecology, is operating under a provisional accreditation. If the problems identified by ACGME are not addressed in accordance within the timeline outlined by the accrediting agency, the council could take measures to begin shutting down all 25 of the hospital’s residency programs as early as next year. Currently, HUH residency programs are responsible for training hundreds of new physicians annually.In a statement issued by the hospital on May 24, officials said, “The findings are unrelated to the quality or delivery of health care at the hospital. The ACGME education standards relate solely to the training and instruction provided to newly graduated physicians. … Hospital officials are confident the newly reorganized GMEC (Graduate Medicine Education Council), including a new chairperson and new members, will improve the graduate medical education components of the hospital.” The statement added the hospital has contracted a consultant to assist in responding to ACGME’s concerns. The statement also notes that the possible closure of any of the hospital’s residency programs would not affect the ability of current residents to complete their programs. What the statement does not mention, however, is that loss of accreditation would prohibit the hospital from admitting any new residents until the accreditation can be re-instituted. Cynthia Taradejna, who heads the institutional review committee at the ACGME, declined to comment citing member confidentiality.These events come at a particularly awkward time for Howard University President H. Patrick Swygert who, together with Virgil Ecton, the vice president of institutional advancement, and university trustees, just launched a $250 million capital campaign in March (see Black Issues, March 14). The campaign, it should be noted, is focused on the academic programs of the university and not the hospital.Still, HUH is owned and operated by the university and together with the Howard College of Medicine plays a critical role in the nation’s production of African American physicians, a group that, according to the Association of American Medical Colleges, is in painfully short supply. Of the more than 600,000 physicians practicing in the United States, only about 21,500 (3 percent) are African American, according to the U.S. Census Bureau. HUH is the only historically Black hospital affiliated with a comprehensive historically Black university that operates its own medical school. The nation’s two other historically Black teaching hospitals are: Meharry Hospital, which is affiliated with the Meharry Medical College; and King-Drew hospital, which has been owned and operated by the Los Angeles County Department of Health Services since its inception and is affiliated with the Charles R. Drew University of Medicine and Science and the University of California-Los Angeles. The nation’s fourth historically Black medical school, Morehouse School of Medicine, does not have its own hospital.According to ACGME records, Howard’s 25 residency programs currently employ 341 residents, many of whom are African American or of African descent. In addition to being an important training ground for Black doctors from around the globe, the hospital plays an essential role in the provision of health care services to the majority-Black population of Washington.Dr. Kevin G. Hurtt, a Frederick, Md.-based surgeon who is a graduate of the Howard University College of Medicine, and a former assistant professor and chief of laparoscopic surgery at HUH, says if the hospital is unable to satisfy ACGME demands, closure of the residency programs, while problematic, would not necessarily be catastrophic to the future of the hospital. “It would affect the attending physicians, of course, because they would have to pick up the slack to fill the void left by the residents. But it wouldn’t mean that the hospital would have to close or that the quality of care for patients would be diminished,” he says. Nonetheless, he concedes the loss of any of the residency programs would be unfortunate. “The long-term sequelae of the closure of residency programs, is that the total number of Blacks finishing subspecialties will most likely suffer,” Hurtt says. “Specifically in the very competitive subspecialties like emergency medicine.” Perez agrees the residency programs at Howard are invaluable, especially given the gross health disparities that exist between African Americans and their White peers.“We need people who know how to talk to, treat and keep us in good health,” she says. “That is the specialty of our institutions.”Perez adds that beyond their expertise in cultural competency, historically Black teaching hospitals are places where aspiring physicians can be mentored by Black doctors who are at the top of their field.Today HUH is one of six teaching hospitals serving the District of Columbia. The 286-bed facility employs 2,200 physicians (including residents), nurses and support staff; admitted 13,127 patients last year; managed 46,579 emergency room visits; and performed 7,000 surgeries. The average daily census at the hospital last year was 245 patients.While the majority of its patients continue to be African American, the hospital sees patients from a global array of ethnic, racial and religious backgrounds and offers a comprehensive range of health services. Many of the attending physicians working at the hospital also hold academic teaching posts at the Howard University College of Medicine. In 2001, Howard University Hospital ranked 39th on U.S. News & World Report’s “Best Hospitals” listing in the field of heart specialty. The divisions of rheumatology and hormone disorders also have ranked among the magazine’s top 50 in recent years.While public sources of information about how graduates from the hospital’s residency programs compare to those of other hospitals are limited, one indicator is the passage rate of residents on the American Board of Internal Medicine (ABIM) exam. Data reflecting passage rates on the ABIM exam for the years 1999-2001 show the Howard University program had a passage rate of 89 percent. This compares to 96 percent for Georgetown University’s program, 88 percent for George Washington University, 86 percent for Morehouse College, 75 percent for Meharry and 56 percent for King-Drew. Among the historically Black institutions, Howard had the largest number of residents who took and passed the exam (66/59).
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